JAMDA published a recent study that assessed whether using coronavirus disease 2019 (COVID-19) community activity levels can accurately inform strategies for routine testing of facility staff for active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Of the staff tested, 28% were certified nursing assistants (CNAs) who accounted for 36.9% of all staff testing positive. Similarly, licensed practice nurses (LPNs) were 1.4% of staff but 4.7% positive. The study failed to observe a meaningful threshold of community COVID-19 activity for the purpose of predicting nursing homes with any positive staff.
Guidance issued by the Centers for Medicare and Medicaid Services (CMS) in August 2020 sets the minimum frequency of routine testing for nursing home staff based on county positivity rates. Using the recommended 5% county positivity rate to require weekly testing may miss asymptomatic infections among nursing home staff. Further data on results of all-staff testing efforts, particularly with the implementation of new, widespread strategies such as point-of-care testing is needed to guide policy to protect high-risk nursing home residents and staff. If the goal is to identify all asymptomatic SARS-CoV-2 infected nursing home staff, a comprehensive, repeat testing may be needed regardless of community-level activity.
Again, we are fighting an invisible force, one that we know little about. CDC and CMS continue to make headway in the battle however sometimes we need to take a step back and determine if what we are doing makes sense. Stay the course, stay strong, stay well, mask up, and stay tuned!